Experiential learning for junior residents as a part of community-based medical education in Japan

Figures & data

Table 1. Experiential learning scale [11].

Concrete Experience	1. Accept difficult tasks.
	2. Try without fear of failure.
	3. Always try new things.
Reflective Observation	4. Review experiences from diverse perspectives.
	5. Collect necessary information and analyze experiences.
Abstract Conceptualization	6. Find common principles for various work situations.
	7. Break down the results of experience into your own knowledge.
	8. Find tips on jobs that are applicable to other situations.
Active Experimentation	9. Experiment to see whether certain ways of doing things can be used in other situations.
	10. Test whether or not your way of doing something is correct.

Table 2. Subject background.

Subject	Sex	Department aspiring to provide services for	Teaching hospital served in the previous year	Period of clinical practice (months)
Dr. A	Male	Surgery	University Hospital	12
Dr. B	Male	Psychiatry	University Hospital	13
Dr. C	Female	Pediatrics	Municipal Hospital	14
Dr. D	Female	Otorhinolaryngology	Overseas Training	28
Dr. E	Female	Anesthesiology	Municipal Hospital	17
Dr. F	Male	Endocrinology	University Hospital	18
Dr. G	Male	Cardiovascular Internal Medicine	Municipal Hospital	21
Dr. H	Female	Respiratory Medicine	Municipal Hospital	22
Dr. I	Male	Ophthalmology	Municipal Hospital	23
Dr. J	Male	Respiratory Medicine	University Hospital	14

Table 3. Identified themes and categories.

Category	Subcategory	Identified theme
Reflective Observation	Approaching Elderly Patients	The importance of interviewing the family.
		Awareness of collaborating with caregivers when providing medical care to elderly patients.
		Aware of problems regarding inconvenient home environments.
		The need to realize the importance of being aware of the social security system when providing medical care.
		Acquiring awareness of providing a thorough explanation of conditions prior to discharge from hospital.
	Community-oriented Approach	Gaining a perspective on the community.
	Family-oriented medicine/care	The importance of grief care for the family.
	Brainstorming	The importance of reflection in learning.
		The importance of guidance that emphasizes autonomy.
	Outpatient Medicine	The importance of time management in medical care.
		Difficulty in making policy decisions in settings different from hospitals.
		Awareness of the fact that looking into patient backgrounds makes the chronic case treatment interesting.
		Realizing the importance of taking the initiative to incorporate a physical examination.
		Realizing one’s own issues involved in outpatient medicine.
	Patient-centered Medical Care	The approach to focus on why patients really come for a consultation.
		Awareness of the ill-effects of biomedical-centered medical care.
	Multidisciplinary Collaboration	Recognizing the importance of communicating with other disciplines.
	Communication	The importance of interpretation models.
		The need for management that takes into account the personality and behavior of patients.
		Recognition of patients who are easy/difficult to deal with.
Abstract Conceptualization	Approaching Elderly Patients	Acquisition of clinical skills considering the ill-effects of hospitalization on elderly patients.
		Acquisition of approach to watch for issues that are unique to elderly patients.
		The approach of considering medication adherence right from the time of prescription.
		Awareness of frailty being the reason for elderly patients visiting the doctor.
	Outpatient Medicine	Awareness of the outpatient strategy for treating patients in a series of shorter sessions.
		Awareness of the strategy of using visuals in guiding patients.
		Efforts to reduce drug dosage.
	Communication	Creating an atmosphere in which patients feel at ease to talk using ‘chime-in,’ ‘silence,’ and ‘smiles.’
Active Experimentation	Approaching Elderly Patients	Strategy of not interrupting when interviewing elderly patients.
		Information collection with priority in mind when treating elderly patients.
		Proper use of differentiated communication with patients with dementia and their families.
		Strategy to pay special attention to the elderly in trouble.
		Use of interviews to comprehensively ascertain the condition and needs of the elderly.
	Outpatient Medicine	Strategy to change the interview approach according to each patient.
		Awareness of narrowing down the focus when a patient has many complaints.
		Awareness of carefully evaluating the necessity of tests beforehand.
		Strategy to overcome the situation while dealing with difficult infants by focusing on the task at hand.
		Skill to ‘handle’ patients during medical check-ups.
	Health Promotion and Disease Prevention	Sense of approaching even one item on health promotion and disease prevention.
		Making an effort to ask detailed questions regarding daily life when giving lifestyle guidance.
		Approach to change behavior by re-evaluating the surrounding environment.
		Strategy to change interview approach depending on the patient.
	Multidisciplinary Collaboration	Strategy to get multiple disciplines involved.
	Communication	Approach to alleviate patient anxiety.
		Actively providing topics of conversation for quiet patients.
		Strategy to focus on the behavior of nonverbal patients.
		Strategy of stating the conversation from surrounding information when talking with adolescents about their sexual medical history.
		Actively using open-ended questions to make people comfortable with sharing information.
		Starting with small talk to create an atmosphere where people are comfortable with sharing information.
		Effort to encourage patients to talk spontaneously during the interview.
		Effort to encourage patients to talk by being silent.
		Sense of appreciating what patients have said.
		Effort to understand exactly what patients are saying when they start to talk.
	Patient-centered Medical Care	Acquiring consideration for the psychosocial aspects of patients.
		Acquisition of clinical approach that values the reason why patients visit the doctor.
		Effort to focus on only one thing for anxious/irritable patients.
	Brainstorming	Sense of ‘stealing’ techniques from a lead physician you respect.
	Family-oriented Medicine/Care	Active use of family trees.
		Strategy to make the natural progression from talking about diet to asking about other background information (e.g. family).

Table 4. Changes in the experiential learning scores after community based medical training.

	Before training	After training	p value	Effect size (Cohen’s d)
Dr. A	38	40
Dr. B	36	41
Dr. C	25	32
Dr. D	40	48
Dr. E	34	37
Dr. F	36	40
Dr. G	44	50
Dr. H	39	44
Dr. I	45	49
Dr. J	33	37
Mean (SD)	37.0 (5.8)	41.8 (5.9)	0.005	0.82

Dhital R, Subedi M, Prasai N, et al. Learning from Primary Health Care Centers in Nepal: reflective writings on experiential learning of third year Nepalese medical students. BMC Res Notes. 2015;8:741.

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